Meta-analysis of efficacy of primary tumor resection for asymptomatic metastatic colorectal cancer with unresectable metastases
10.3760/cma.j.issn115396-20210609-00215
- VernacularTitle:预防性原发灶切除在转移瘤不可切除且原发灶无症状的转移性结直肠癌中有效性及安全性的Meta分析
- Author:
Yang LI
1
;
Chang WANG
;
Quan WANG
;
Kai SHEN
;
Yingjiang YE
;
Kewei JIANG
Author Information
1. 北京大学人民医院胃肠外科 100044
- Keywords:
Colorectal neoplasms;
Meta analysis;
Metastatic colorectal neoplasms;
Asymptomatic;
Validation studies;
Primary tumor resection
- From:
International Journal of Surgery
2021;48(8):519-526
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and safety of primary tumor resection for asymptomatic metastatic colorectal cancer with unresectable metastases.Methods:A literature search was conducted in PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure and WanFang databases to identify studies comparing primary tumor resection and systemic treatment for asymptomatic metastatic colorectal cancer with unresectable metastases until March 31, 2021 (inchuding RCTs and non-RCTs) . The search strategy was: (((colorectal cancer) OR (colorectal neoplasms) OR (colon cancer) OR (colon neoplasms) OR (rectal cancer) OR (rectal neoplasms)) AND ((metastatic) OR (stage Ⅳ)) AND (asymptomatic) AND (primary tumor resection)). Review manager (RevMan) (Version 5.3.0, Cochrane Collaboration, Oxford, UK) was used to perform the statistical analysis.Results:A total of 14 original studies (RCT: 1; cohort study: 13) were included in this analysis with a total of 2123 patients (primary tumor resection: 1162 cases, systemic treatment: 961 cases). The results of this Meta-analysis showed that PTR group had a significantly improved overall survival in 1-year overall survival ( HR=0.80, 95% CI: 0.67~0.95, P=0.01), 2-year overall survival ( HR=0.81, 95% CI: 0.71~0.93, P=0.002), 3-year overall survival ( HR=0.82, 95% CI: 0.72~0.92, P=0.001), 4-year overall survival ( HR=0.86, 95% CI: 0.75~0.98, P=0.02) and 5-year overall survival ( HR=0.85, 95% CI: 0.74~0.97, P=0.02). The median survival time of PTR group was 4.35 months longer than that of systemic treatment group ( MD=4.35, 95% CI: 0.99~7.72, P=0.015). Conclusions:The current evidence suggests that primary tumor resection may be a potentially safe and feasible treatment strategy for asymptomatic metastatic colorectal cancer with unresectable metastases. Large sample size prospective randomized controlled trials are needed to validate our findings in the future.
